Hepatitis C – A Silent Epidemic
||Dr. Joseph Masci
The Centers for Disease Control and Prevention (CDC) has proposed that Baby Boomers – people born in the U.S. from 1945 through 1965 – be added to the list of those who should be tested for Hepatitis C because they are at high risk of contracting the disease. Dr. Joseph Masci, Director of Medicine at Elmhurst Hospital Center, discusses Hepatitis C, who should get tested and how to protect yourself and stay healthy.
Why has the medical community focused on Hepatitis C?
Hepatitis C is a life-threatening liver infection that affects about 3.2 million Americans, about 75 percent of whom are “Baby Boomers” – people born from 1945 through 1965. It is the leading cause of liver transplants and liver cancer in the U.S. The number of people dying annually from Hepatitis C-related conditions is on the rise, and reached 15,000 in 2007.
Hepatitis C is known as a “silent epidemic” because a person can be infected but have no symptoms for many years. The irony is that while new treatments can cure the majority of Hepatitis C cases, most people don’t seek care because they just don’t know they’re infected.Yet early detection is key to preventing prolonged liver damage and disease.
Hepatitis is the name of a family of viral infections that affect the liver. In the U.S., the most common types are Hepatitis A, B and C. Hepatitis A and B can be prevented with vaccines. But there is no vaccine to prevent the Hepatitis C virus (HCV).
How do you get it?
Hepatitis C spreads by needle sharing, getting stuck by a needle, body piercing, tattooing, sexual contact, from mother- to-child at the time of birth, through blood transfusion, and through hemodialysis. The risk is greatest with needle sharing. There are approximately 19,000 new cases of Hepatitis C every year.
Who should be tested?
According to the existing guidelines, those who should be tested are persons who:
- Have ever injected illegal drugs.
- Received clotting factor concentrates before 1997.
- Received blood transfusion or organ transplant before 1992.
- Have ever been on chronic hemodialysis.
- Have evidence of liver disease.
- Are HIV-infected.
- Are children born to HIV-infected mothers.
- Are children born to HCV-infected mothers.
- Have received a needle-stick injury (such as healthcare workers).
What exactly is the CDC’s proposed new recommendation?
The CDC is recommending a one-time Hepatitis C test for all persons born from 1945 through 1965 to identify hidden infections, provide prompt and appropriate treatment, and avoid Hepatitis C-related illness and death. The CDC estimates that expanding the testing recommendations could identify 800,000 additional cases of people with Hepatitis C virus infection, and providing these people with care and treatment could save more than 120,000 lives.
Many Baby Boomers were infected with the Hepatitis C virus when they were in their teens and 20’s. Some may have been infected through blood transfusions or organ transplants before widespread blood screening began in 1992. Others may have been infected through drug use, even if it was only once and even if it was decades ago. Many Baby Boomers don’t remember or don’t want to talk about the events that put them at risk, and have never been tested.
What happens when a patient tests positive?
At HHC, the patient is referred for evaluation and treatment. We assess the degree of fibrosis, or scarring, of the liver; we identify the genotype causing the infection; and we discuss options with the patient including monitoring the disease and medical treatment.
All HIV patients are tested for HCV when they enter care. Last year HHC estimated that 25% of the 19,000 HIV patients in the system were HCV-infected. At Elmhurst, about 10% of the approximately 1,200 HIV patients we follow are co-infected with HCV.
What’s next regarding Hepatitis C?
On the national level, the CDC has invited the public to comment on the draft expanded recommendations by going to www.regulations.gov, docket number CDC-2012-0005, by June 8, and will issue final recommendations later this year. At HHC, we continue to test patients who are HIV positive to determine whether they are also positive for the Hepatitis C virus, we link them to care, and we continue to work toward making Hepatitis C testing part of standard care for all those who are at risk.